ELTROMBOPAG
Manner of administration:Oral
Restriction
Indication: Severe aplastic anaemia
Treatment phase: Initial treatment - Second line treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 3 | Max qty units: 84 | # of repeats: 3 | DPMQ: $3,733.23 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Revolade | |||||
Manner of administration:Oral
Restriction
Indication: Severe aplastic anaemia
Treatment phase: Continuing treatment - Second line treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 3 | Max qty units: 84 | # of repeats: 5 | DPMQ: $3,733.23 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Revolade | |||||
Manner of administration:Oral
Restriction
Indication: Severe aplastic anaemia
Treatment phase: Continuing treatment - Second line treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 3 | Max qty units: 84 | # of repeats: 5 | DPMQ: $3,684.36 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Revolade | |||||
Manner of administration:Oral
Restriction
Indication: Severe aplastic anaemia
Treatment phase: First line treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 3 | Max qty units: 84 | # of repeats: 5 | DPMQ: $3,684.36 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Revolade | |||||
Manner of administration:Oral
Restriction
Indication: Severe aplastic anaemia
Treatment phase: First line treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 3 | Max qty units: 84 | # of repeats: 5 | DPMQ: $3,733.23 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Revolade | |||||
Manner of administration:Oral
Restriction
Indication: Severe aplastic anaemia
Treatment phase: Initial treatment - Second line treatment
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 3 | Max qty units: 84 | # of repeats: 3 | DPMQ: $3,684.36 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Revolade | |||||
Manner of administration:Oral
Restriction
Indication: Severe thrombocytopenia
Treatment phase: Initial treatment - New patient
Restriction
Indication: Severe thrombocytopenia
Treatment phase: First Continuing treatment or Re-initiation of interrupted continuing treatment
Restriction
Indication: Severe thrombocytopenia
Treatment phase: Second or Subsequent Continuing treatment
Restriction
Indication: Severe thrombocytopenia
Treatment phase: Balance of supply or change of therapy
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 5 | DPMQ: $1,228.12 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Revolade | |||||
Manner of administration:Oral
Restriction
Indication: Severe thrombocytopenia
Treatment phase: Initial treatment - New patient
Restriction
Indication: Severe thrombocytopenia
Treatment phase: First Continuing treatment or Re-initiation of interrupted continuing treatment
Restriction
Indication: Severe thrombocytopenia
Treatment phase: Second or Subsequent Continuing treatment
Restriction
Indication: Severe thrombocytopenia
Treatment phase: Balance of supply or change of therapy
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
|---|---|---|---|---|---|
| Max qty packs: 1 | Max qty units: 28 | # of repeats: 5 | DPMQ: $1,277.00 | Max safety net: $25.00 | General Patient Charge: $25.00 |
| Available brands | |||||
| Revolade | |||||